Ray Burke is the Senior Communications and Advocacy Officer with Mental Health Reform.
Homelessness and access to mental health services
Access to secure and long-term housing is fundamental to promoting the recovery of a person experiencing homelessness from their mental health difficulty. When we talk about the provision of good quality, recovery orientated mental health services for people who are homeless, what we always need to remember is that as a priority, services must ensure people who are homeless cease being homeless as a matter of urgency.
Homelessness is bad for mental health
Severe mental health difficulties are more prevalent among people who are homeless than the rest of the population. In 2013, Dublin Simon’s Health Snapshot showed that 71% of its clients had a diagnosed mental health difficulty, of which 22% had a diagnosis of psychosis or schizophrenia. The prevalence of schizophrenia expected in the general population is approximately 1%.
There are lots of reasons why mental health difficulties and serious mental health conditions are more prevalent among the homeless community than the general population. The most obvious reason is that becoming homeless has an extremely detrimental impact on a person’s mental health. In a recent study undertaken by Mental Health Reform into the experience people who are homeless have of accessing mental health service and supports, participants detailed the profound sense of loneliness and abandonment they felt when they became homeless.
“You wake up in the mornings and you’re on your own. God, I hate it, hate it. […] I’d wake up in the mornings crying. I mean, how could that be? I’d wake up crying!” […] (Participant 6, Male)
Another reason mental health difficulties and serious mental health conditions are more prevalent among the homeless community than the general population, is that a pre-existing mental health difficulty increases the risk of a person becoming homeless. Research conducted in the Tallaght inpatient mental health service found a high proportion of people being treated there had an urgent housing need, with an average of 38% of inpatients and 98% of long stay/delayed discharge inpatients having a housing need. The study also found that a person in that mental health service was discharged into homeless services every 9.4 days.
The presence of trauma in a person’s life, or a problematic relationship with drugs or alcohol can also result in homelessness and serious mental health difficulties. These have been discussed in detail by Dr Sharon Labert in her blog for Merchants Quay Ireland, available here.
What does our national mental health policy say?
Our national mental health policy, A Vision for Change, sets out certain key provisions for people who are homeless or at risk of homelessness. It includes key recommendations on preventing people who have mental health difficulties from becoming homeless in the first place. The policy also sets out a range of provisions for delivering mental health services to people who are already homeless, with a priority focus on promoting access to specialist mental health services. A Vision for Change recommends:
- A range of suitable, affordable housing options to prevent people with mental health difficulties becoming homeless
- A generic Community Mental Health Teams (CMHT) in every area should have responsibility and accountability for delivering mental health services to the homeless population, including offering assertive outreach.
- Two specialist teams should be set up, one in North Dublin and one in South Dublin, to provide a mental health service to the homeless population.
- All community mental health teams should adopt practices to help prevent service users becoming homeless, such as an assessment of housing need/living circumstances for all people referred to mental health services.
- Integration and coordination between statutory and voluntary housing bodies and mental health services at catchment area level should be encouraged.
What is the reality?
While there is considerable dedicated and progressive work going on in homeless and mental health services across the country, we know from speaking with people who are homeless that their mental health needs are not being adequately met by statutory mental health services.
Many people that are homeless are not able to access their local GP or Community Mental Health Team (CMHT) because they do not have an address or because they are using drugs or alcohol. CMHTs often struggle to meet the demand of the general population and can lack the necessary training or staffing to work effectively with people in the homeless community, in a way that will support their full recovery. There are four specialised CMHTs for people who are homeless and have a mental health difficulty; two in Dublin, one in Cork and one in Waterford. These specialist teams are inadequately staffed and resourced, which can result in huge difficulties meeting demand. For example, one specialist CMHT in Dublin was unable to accept any new referrals for 6 months in 2018 due to significant staffing shortages.
Furthermore, we know that people with mental health difficulties are routinely discharged into homeless services or are kept long term in inpatient units due to a lack of housing provision. The poor availability of housing and housing supports makes is extremely difficult for mental health teams to reach the ambitions set out in A Vision for Change.
Access to housing and housing supports is of paramount importance, not only to prevent people with mental health difficulties becoming homeless, but to quickly end a person’s homelessness and support their recovery from a mental health difficulty. In practical terms, a solution to this is the availability of social and affordable housing for people. It also means appropriately funding organisations like Merchants Quay Ireland (MQI), Dublin Simon, Focus Ireland, HAIL and others so that they can support people to find a home and sustain independent living, as soon as possible.
More resources and planning are needed to adequately meet the demand for mental health services among the homeless population, making it easing for people to access services when they need them. This includes ensuring GPs and generic CMHTs are sufficiently trained and resourced to work with people who are homeless and have mental health difficulties. Services should also be available 24 hours a day, 7 days a week, so that people can get the support they need where and when they need it. All mental health services should also be capable of providing some level of care for a person who is homeless that may have both a mental health and substance use difficulty.
Services should be aware of the double and sometimes triple stigma homelessness, mental health and substance use problems present. Services should be trained not only to be aware of this stigma, but to treat people in these circumstances with the utmost dignity and respect.
Specialist teams should be fully staffed and capable of meeting demand within the homeless community for those with high support needs. This includes having fully staffed teams that can engage in assertive outreach, aftercare planning and support people back into a home.
You can read Mental Health Reform’s vision of better mental health services for homeless people in much greater detail here.
Mental Health Reform is the national coalition on mental health in Ireland. We have over 70 Mental Health Reform provide a unified voice campaigning to drive progressive reform of mental health services and supports in Ireland.
To join the campaign for better mental health services visit www.mentalhealthreform.ie